Category Archives: Sex And Aging

Sexuality and Illness – Breaking the Silence


(This is a Companion piece to yesterday’s posting. You’ll find yesterday’s posting HERE!)

By: Anne Katz PhD

Sexuality is much more than having sex even though many people think only about sexual intercourse when they hear the word. Sexuality is sometimes equated with intimacy, but in reality, sexuality is just one way that we connect with a spouse or partner we love (the true meaning of intimacy). Our sexuality encompasses how we see ourselves as men and women, who we are attracted to emotionally and physically, what turns us on (eroticism), our thoughts and fantasies, and yes, also what we do when we are sexually active, either alone or with a partner. Our sexuality is connected to our image of ourselves and it changes over the years as we age and face threats from illness and disability and, eventually, the end of life.seniors_men

Am I still a sexual being?

Illness can affect our sexuality in many different ways. The side effects of treatments for many diseases, including cancer, can cause fatigue. This is often identified as the number one obstacle to sexual activity. Other symptoms of illness such as pain can also affect our interest in being sexually active. But there are other perhaps more subtle issues that impact how we feel about ourselves and, in turn, our desire to be sexual with a partner or alone, or if we even see ourselves as sexual beings. Think about surgery that removes a part of the body that identifies us as female or male. Many women state that after breast cancer and removal of a breast (mastectomy), they no longer feel like a woman; this affects their willingness to appear naked in front of a partner. Medications taken to control advanced prostate cancer can decrease a man’s sexual desire. Men in this situation often forget to express their love for their partner in a physical way, no longer touching them, kissing them, or even holding hands. This loss of physical contact often results in two lonely people.  Humans have a basic need for touch; without that connection, we can end up feeling very lonely.

Just talk about it!

seniors_in_bedCommunication lies at the heart of sexuality. Talk to your partner about what you are feeling, how you feel about your body, and what you want in terms of touch. Ask how you can meet your partner’s needs for touch and affection. The most important thing you can do is to express yourself in words. Non-verbal communication and not talking are open to misinterpretation and can lead to hurt feelings. Our sexuality changes with age and time and illness; we may not feel the same way about our bodies or our partner’s body that we did 20, 30 or more years ago. That does not mean we feel worse – with age comes acceptance for many of us – but we do need to let go of what was, and look at what is and what is possible.

The role of health care providers

Health care providers should be asking about changes to sexuality because of illness or treatment, but they often don’t. They may be reluctant to bring up what they see as a sensitive topic and think that if it’s important to the patient, then he or she will ask about it. This is not good. Patients often wait to see if their health care provider asks about something and if they don’t, they think that it’s not important. This results in a silence and leaves the impression that sexuality is a taboo topic.senior intimacy02

Some health care providers are afraid that they won’t know the answer to a question about sexuality because nursing and medical schools don’t provide much in the way of education on this topic. And some health care providers appear to be too busy to talk about the more emotional aspects of living with illness. This is a great pity as sexuality is important to all of us – patients, partners, health care providers. It’s an important aspect of quality of life from adolescence to old age, in health and at the end of life when touch and love are so important.

Ask for a referral

If you want to talk about this, just do it! Tell your health care provider that you want to talk about changes in your body or your relationship or your sex life! Ask for a referral to a counselor or sexuality counselor or therapist or social worker. It may take a bit of work to get the help you need, but there is help.

Complete Article HERE!

Sexuality at the End of Life

By Anne Katz RN, PhD

In the terminal stages of the cancer trajectory, sexuality is often regarded as not important by health care providers. The need or ability to participate in sexual activity may wane in the terminal stages of illness, but the need for touch, intimacy, and how one views oneself don’t necessarily wane in tandem. Individuals may in fact suffer from the absence of loving and intimate touch in the final months, weeks, or days of life.head:heart

It is often assumed that when life nears its end, individuals and couples are not concerned about sexual issues and so this is not talked about. This attitude is borne out by the paucity of information about this topic.

Communicating About Sexuality with the Terminally Ill

Attitudes of health care professionals may act as a barrier to the discussion and assessment of sexuality at the end of life.

  • We bring to our practice a set of attitudes, beliefs and knowledge that we assume applies equally to our patients.
  • We may also be uncomfortable with talking about sexuality with patients or with the idea that very ill patients and/or their partners may have sexual needs at this time.
  • Our experience during our training and practice may lead us to believe that patients at the end of life are not interested in what we commonly perceive as sexual. How often do we see a patient and their partner in bed together or in an intimate embrace?
  • We may never have seen this because the circumstances of hospitals and even hospice may be such that privacy for the couple can never be assured and so couples do not attempt to lie together.

intimacy-320x320For the patient who remains at home during the final stages of illness the scenario is not that different. Often the patient is moved to a central location, such as a family or living room in the house and no longer has privacy.

  • While this may be more convenient for providing care, it precludes the expression of sexuality, as the patient is always in view.
  • Professional and volunteer helpers are frequently in the house and there may never be a time when the patient is alone or alone with his/her partner, and so is not afforded an opportunity for sexual expression.

Health care providers may not ever talk about sexual functioning at the end of life, assuming that this does not matter at this stage of the illness trajectory.

  • This sends a very clear message to the patient and his/her partner that this is something that is either taboo or of no importance. This in turn makes it more difficult for the patient and/or partner to ask questions or bring up the topic if they think that the subject is not to be talked about.

Sexual Functioning At The End Of Life

Factors affecting sexual functioning at the end of life are essentially the same as those affecting the individual with cancer at any stage of the disease trajectory. These include:go deeper

  • Psychosocial issues such as change in roles, changes in body- and self-image, depression, anxiety, and poor communication.
  • Side effects of treatment may also alter sexual functioning; fatigue, nausea, pain, edema and scarring all play a role in how the patient feels and sees him/herself and how the partner views the patient.
  • Fear of pain may be a major factor in the cessation of sexual activity; the partner may be equally fearful of hurting the patient.

The needs of the couple

Couples may find that in the final stages of illness, emotional connection to the loved one becomes an important part of sexual expression. Verbal communication and physical touching that is non-genital may take the place of previous sexual activity.

  • Many people note that the cessation of sexual activity is one of the many losses that result from the illness, and this has a negative impact on quality of life.
  • Some partners may find it difficult to be sexual when they have taken on much of the day-to-day care of the patient and see their role as caregiver rather than lover.
  • The physical and emotional toll of providing care may be exhausting and may impact on the desire for sexual contact.
  • In addition, some partners find that as the end nears for the ill partner, they need to begin to distance themselves. Part of this may be to avoid intimate touch. This is not wrong but can make the partner feel guilty and more liable to avoid physical interactions.

Addressing sexual needs

senior intimacyCouples may need to be given permission to touch each other at this stage of the illness and health care providers may need to consciously address the physical and attitudinal barriers that prevent this from happening.

  • Privacy issues need to be dealt with. This includes encouraging patients to close their door when private time is desired and having all levels of staff respect this. A sign on the door indicating that the patient is not to be disturbed should be enough to prevent staff from walking in and all staff and visitors should abide by this.
  • Partners should be given explicit permission to lie with the patient in the bed. In an ideal world, double beds could be provided but there are obvious challenges to this in terms of moving beds into and out of rooms, and challenges also for staff who may need to move or turn patients. Kissing, stroking, massaging, and holding the patient is unlikely to cause physical harm and may actually facilitate relaxation and decrease pain.
  • The partner may also be encouraged to participate in the routine care of the patient. Assisting in bathing and applying body lotion may be a non-threatening way of encouraging touch when there is fear of hurting the patient.

Specific strategies for couples who want to continue their usual sexual activities can be suggested depending on what physical or emotional barriers exist. Giving a patient permission to think about their self as sexual in the face of terminal illness is the first step. Offering the patient/couple the opportunity to discuss sexual concerns or needs validates their feelings and may normalize their experience, which in itself may bring comfort.

More specific strategies for symptoms include the following suggestions. senior lesbians

  • Timing of analgesia may need to altered to maximize pain relief and avoid sedation when the couple wants to be sexual. Narcotics, however, can interfere with arousal which may be counterproductive.
  • Fatigue is a common experience in the end stages of cancer and couples/individuals can be encouraged to set realistic goals for what is possible, and to try to use the time of day when they are most rested to be sexual either alone or with their partner.
  • Using a bronchodilator or inhaler before sexual activity may be helpful for patients who are short of breath. Using additional pillows or wedges will allow the patient to be more upright and make breathing easier.
  • Couples may find information about alternative positions for sexual activity very useful.
  • Incontinence or the presence of an indwelling catheter may represent a loss of control and dignity and may be seen as an insurmountable barrier to genital touching.

footprints-leftIt is important to emphasize that there is no right or wrong way of being sexual in the face of terminal illness; whatever the couple or individual chooses to do is appropriate and right for them. It is also not uncommon for couples to find that impending death draws them much closer and they are able to express themselves in ways that they had not for many years.

Complete Article HERE!

Chlamydia at 50… Could it be you?

by Jenny Pogson

senior intimacy

If you think only young people are at risk of sexually transmitted infections, think again – rates could be on the rise in older adults.

With more of us living longer and healthier lives, and divorce a reality of life, many of us are finding new sexual partners later in life.

While an active sex life comes with a myriad of health benefits, experts are warning those of us in mid-life and beyond not to forget the risk of contracting a sexually transmitted infection from a new partner.

Figures suggest rates of infections have been on the increase among older people in the US and UK in recent years and there is a suggestion the same could be happening in Australia.

Chlamydia, a common bacterial STI, is on the up among all age groups in Australia, and has more than doubled in those over 50 since 2005; going from 620 cases to 1446 in 2010.

Gonorrhoea, another bacterial infection, has seen a slight increase in the over 50s, rising from 383 infections in 2005 to 562 in 2010.

While these increases could partly be attributable to more people being tested, the trend has caused concern in some parts of the medical community here and overseas.

Cultural shift

Older people are increasingly likely to be single or experiencing relationship changes these days, according to the UK’s Family Planning Association, which last year ran its first sexual health campaign aimed at over 50s.

It’s much easier to meet new partners, with the advent of internet dating and the ease of international travel. Plus, thanks to advances in healthcare, symptoms of the menopause and erectile dysfunction no longer spell the end of an active sex life.

But despite this, education campaigns about safe sex are generally aimed at younger people; not a great help when it’s often suggested that older people are more likely to feel embarrassed about seeking information about STIs and may lack the knowledge to protect themselves.

And, as noted by Julie Bentley, CEO of the UK’s Family Planning Association, “STIs don’t care about greying hair and a few wrinkles”.

Risky sexual practices

Dr Deborah Bateson, medical director at Family Planning NSW, started researching older women’s views and experience of safe sex after noticing a rise in the number of older women asking for STI tests and being diagnosed with STIs, particularly chlamydia.

The organisation surveyed a sample of women who used internet dating sites and found, compared with younger women, those aged between 40 and 70 were more likely to say they would agree to sex without a condom with a new partner.

Similarly, a telephone survey commissioned by Andrology Australia found that around 40 per cent of men over 40 who have casual sex do not use condoms.

While the reasons behind this willingness to engage in unsafe sex are uncertain, Bateson says older people may have missed out on the safe sex message, which really started to be heavily promoted in the 1980s with the advent of HIV/AIDS.

In addition, older women may no longer be concerned about becoming pregnant and have less of an incentive to use a condom compared with younger women.

“There is a lot of the information around chlamydia that relates to infertility in the future, so again for older women there may be a sense that it’s not relevant for them,” she says.

However, the Family Planning survey did find that older women were just as comfortable as younger women with buying condoms and carry them around.

“There’s obviously something happening when it comes to negotiating their use. Most people know about condoms but it’s just having the skills around being able to raise the subject and being able to negotiate their use at the actual time,” Bateson says.

As with most things in life, prevention is better than cure – something to remember when broaching the topic of safe sex and STIs with a new partner.

“If you’re meeting a new partner, they are probably thinking the same thing as you [about safe sex],” says Bateson.

“So being able to break the ice [about safe sex] can often be a relief for both people.”

Stay safe

Anyone who has had unprotected sex, particularly with several people, is potentially at risk of STIs, says Professor Adrian Mindel, director of the Sexually Transmitted Infections Research Centre based at Westmead Hospital, Sydney.

“People who are changing partners or having new partners, they and their partner should think about being tested,” he says.

“Also think about condom use at least until [you] know [the] relationship is longer lasting and that neither of [you] are going having sex with anyone outside the relationship.”

The UK’s Family Planning Association also stresses that STIs can be passed on through oral sex and when using sex toys – not just through intercourse.

It also notes that the signs and symptoms of some STIs can be mistaken as a normal part of aging, such as vaginal soreness or irregular bleeding.

And remember that often infections don’t result in symptoms, so you may not be aware you have an STI. However, you can still pass an infection on to a sexual partner.

So if you are starting a new sexual relationship or changing partners, here is some expert advice to consider:

  • If you have had unprotected sex, visit your GP to get tested for STIs. This may involve giving a urine sample to test for chlamydia, examination of the genital area for signs of genital warts, or a swab of your genitals to test for STIs such as herpes or gonorrhoea. A blood test may also be required to test for syphilis, HIV and hepatitis B.
  • If you are starting a new relationship, suggest your partner also gets tested.
  • Use a condom with a new partner until you both have been tested for STIs and are certain neither of you is having unprotected sex outside the relationship.
  • If you have symptoms you are concerned about, such as a urethral discharge in men or vaginal discharge, sores or lumps on the genitals, pain when passing urine or abdominal pains in women, see your GP.

Complete Article HERE!

Stretching out of the sexual doldrums

Name: Gwen
Age: 57
Location: Philly
My husband and I have been married for 33 years. Our relationship is hell when it comes to sex. My husband is overweight, and he’s stressed out about his elderly parents. Sex is non-existent. He never was the instigator in our relationship. And he is the kind of guy who thinks having sex on the couch as opposed to the bedroom is adventuresome. He has become so boring. I don’t believe the man feels sex should be that important at our ages. (I’m 57 and he’s 62) I, on the other hand, am more sexually aroused and creative than ever now that I am more mature and the kids are out of the house. Menopause and all the sex on the internet helps too. 😉 Is there anything I can do to make my man return to being a healthy sexual being once again? Thank you, Gwen

No, thank you, Gwen. Your complaint is a familiar one. In fact it’s so familiar I regularly offer therapy groups for couples in long-term relationships. Like you and your old man, these couples have, for one reason or another, hit a wall when it comes to their sex lives.senior intimacy

I take a very unique approach to these groups by inviting both straight and gay couples to the same group. At first I got a lot of resistance. Most couples, both gay and straight, think there is nothing to be learned from a couple unlike them. They can’t imagine why I would want to integrate the group in such a manner. I think most of my couples feel more comfortable being in a segregated group — straight folks with straight folks, gay folks with gay folks.

But that is of course the reason I integrate the groups. I don’t want them to feel all comfy and cozy, I wanted them to work and learn and stretch themselves out of their sexual doldrums. At first, I had to ask all my couples to suspend judgment about an integrated group until they had an opportunity to participate in one. Now I don’t encounter so much resistance. Word’s gotten out that this is a really creative solution to an otherwise tricky problem. And that old married couples, regardless if they are gay, lesbian or straight have very similar problems. And they can and do learn from one another.

To your specific issue, Gwen, I’m sad to say there’s not much you can do to beef up your sex life if there’s no interest on the part of your husband to do so. I mean, you can lead the horse to the cooch, but you can’t make him lick, if ya know what I mean.

Fat man holding a measurement tape against white background

Fat man holding a measurement tape against white background

You confide that you husband is overweight and stressed; this is not a happy combination when it comes to his sexual response cycle. In fact, your husband sounds like a heart attack waiting to happen. Perhaps if your challenged him about his general health — encourage weight loss and stress reduction, you might find that this would also reignite his sex drive. It’s worth a try.

And thank you for mentioning menopause. So many women find the changes that take place in midlife confusing and disorientating. It’s so good to hear from a woman who is eager to explore and enjoy her sexuality post-menopause.

Men also go through changes, in midlife. There’s even a name for it — andropause — the male menopause as it were. It’s clear that as we age, both women and men need more time and stimulation in which to get aroused. The slower, more sensuous foreplay that often results is a welcome change for most women and even some men.

Increased focus on sensuality, intimacy, and communication can help a sexual relationship remain rewarding even well into our senior years. I think you already know this, Gwen, but many women in my audience don’t.sensual touch

If your husband is avoiding intercourse, there still many ways of expressing your love and staying connected:

  • Hugging, cuddling, kissing
  • reading erotica aloud together
  • Touching, stroking, massage, sensual baths
  • Masturbation and oral sex

However, if your husband is more wedded to food and stress than he is to you, and if he continues to refuse to join you in finding an appropriate outlet for your sexual frustration, then it’s up to you to make this happen on your own. 57 is way too young to say goodbye to your sex life.

May I suggest joining a women’s group. Not a therapy group, but more of a support group or activities group. Getting out of the house, involving yourself with other self-actualized mature women, may uncover the secret solutions other women have put in place to find sexual satisfaction when they are without a partner or have a partner who’s no longer interested in a sex life with them. I think you will be surprised by how creative your sisters can be. Make it happen, Gwen. Don’t sink to the lowest common denominator of living a sexless life.

Good luck

Review: The Ultimate Guide To Sex After 50

Hey sex fans!

2015 is turning out to be a banner year for sex positive books. Here it is still only January and this is my second review of a noteworthy book about human sexuality.

A few weeks ago, January 8th to be precise, I introduced you to Cooper S. Beckett’s book, My Life on the Swingset.  In that review I mentioned that Cooper had been a guest on my Sex EDGE-U-cation Show.

Today’s review features a book written by another guest on my show, but this time it was the SEX WISDOM Show. Today’s book, The Ultimate Guide to Sex After Fifty: How to Maintain – or Regain – a Spicy, Satisfying Sex Life, was written by the brilliant, Joan Price.

Joan is on the forefront of our culture’s discussion on ageless sexuality. She is the author of Ult+Guide+Sex+50+covertwo other books, Better Than I Ever Expected: Straight Talk about Sex After Sixty and Naked at Our Age: Talking Out Loud about Senior Sex. She is a sought-after speaker and workshop leader. And, if that weren’t enough, she’s also a fitness expert. This woman is a ball of fire, sex fans, and an absolutely charming interview. Be sure to listen to the two-part interview I did with Joan, you’ll find them archived HERE and HERE!

Joan and I talked about some the many myths that surround sex during life’s second half; she covers this topic more in depth in her new book. The misinformation about sex after 50 is so pervasive that even many of us seniors and elders perpetrate it. And, of course, we’re often the butt of jokes.

1. We lose interest in sex as we age.
2. Senior sex is boring.
3. Dating as a senior/elder is depressing and hopeless.
4. Seniors with arousal issues just give up on sex.
5. Sex becomes more frequent as we age.
6. Real sex must involve intercourse and orgasm.
7. Health concerns and menopause will end one’s sex life.
8. If you’re interested in sex after you turn 50, you’re a dirty old man/woman.

The Ultimate Guide to Sex After Fifty is the perfect antidote to the dismissive and degrading way that so much of the popular culture deals with senior and elder sexuality. Joan celebrates not only the existence and appropriateness of sexual desire for seniors and elders, but how sex can and does increase the health and wellbeing of older people.

Joan states her credo in the Introduction.
“…being sexual at this time of life means:
• Enjoying arousal and orgasm, with or without a partner
• Having a zesty, sex-positive frame of mind
• Being open to new possibilities
• Giving pleasure to this body that is capable of great delights
• Making a commitment to myself to be sexually aware and healthy”

Joan invites her readers to join her in conversation. And a big part of that conversation is being aware of what’s going on with our body as we age. Being attuned to that, and being able to communicate that to a partner, is key to great senior/elder sex. (To be frank, it’s the secret of great sex at any age, but I digress.) To that end, Joan includes in her book actual comments from real people that she has encountered in her work. These anecdotes reflect an array of feelings that underscore the conflicts, successes, and complexities of real life situations. And this being the Ultimate Guide, Joan includes the input from many of our colleagues who weigh in with their expert opinion on the topics she is addressing.

I love that Joan often makes the point that having a fulfilling sex life is not dependent on having a partner. Lot of seniors and elders are without a partner, but that ought not be an impediment to sexual enjoyment. Self-pleasuring, with one’s hand, or any of the myriad toys available to us, is the foundation of a rich, healthy, rewarding, and ageless sex life.

Joan also examines a topic near and dear to my life. In my book, The Amateur’s Guide To Death And Dying; Enhancing The End of Life, I took great pains to include a chapter about the sex and intimacy needs of sick, elder, and dying people. Joan does something similar in her chapter — Cancer, Cancer Treatment, And Sex. I am so grateful that Join addressed this timely topic, suggesting, as she does, that people challenged with cancer, or any other chronic condition for that matter, take their sexual performance questions to their doctors. I think we both believe this will go a long way to underscore the notion that wellbeing is not merely about absence of disease, it’s’ about quality of life. There’s also a marvelous section about sex and grief too.

And, just so you know, this isn’t a hetero-centric book. Joan includes all sexual orientations and lifestyles.

I highly recommend Joan’s new book, The Ultimate Guide to Sex After Fifty, to everyone. If you are a fellow senior or elder, this book is chock full of important and practical information about things we care about. It also provides much needed support and encouragement as we make our way through this season of life. If you’re not a senior or elder, this book is an indispensable resource for you too. Not just so that you will be sensitive to the needs of others, but that you’ll grow in appreciation of the fact that sex is for a lifetime. And hey, you just might learn a little something new from someone who isn’t “new”.

I want to say a special thanks to Cleis Press, Joan’s publisher, for sending me this review copy of The Ultimate Guide to Sex After Fifty.

Kudos to Joan! Your book is a marvel.

Be sure to check out Joan’s websites: and

PS:  This book would make a fantastic Valentine’s Day gift.

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